Characteristic Clinical FeaturesĪcute central cord syndrome is seen in a majority of such patients. Most often seen at the C2 level, such fractures are seen involving the lower cervical spine in young patients. Hyperextension teardrop fracture is a type of hyperextension injury, secondary to avulsion of the fibers of the anterior longitudinal ligament (ALL) off the anteroinferior endplate of the vertebral body. Hyperextension forces account for up to 38% of blunt traumatic injuries to the cervical spine. In The Teaching Files: Brain and Spine, 2012 Discussion Definition/Background An associated osseous component is seen in one-half to one-third of cases. It is typically a ligamentous injury with involvement of the anterior longitudinal ligament, annulus, disc, spinal cord, and posterior longitudinal ligament. Hyperextension dislocation injuries typically belong to the direct contact mechanism of injury described above. Noncontact hyperextension injuries to the neck are referred to as whiplash injuries, and result from unrestrained neck motion during a rear-end motor vehicle collision. This type of injury is often seen in trauma to the forehead from an anterior physical force such as the dashboard or steering wheel in a motor vehicle accident. With direct contact injury, an impact to the forehead produces anterior widening or distraction and posterior narrowing or compression of the cervical spine. Hyperextension injuries to the spine can result from a direct contact mechanism or a noncontact mechanism. In The Teaching Files: Brain and Spine, 2012 Definition/Background Hyperextension injuries are typically unstable owing to the disruption of the stabilizing ligamentous elements and injury to the intervertebral disks. The vertebral arteries may be damaged in cervical extension injuries, particularly in people with severe spondylosis. Elderly individuals with cervical spondylosis are particularly susceptible to hyperextension injuries, and even moderate hyperextension may produce cord injury. Hyperextension injuries result in disruption of the anterior and middle spinal columns in tension, reducing the AP diameter of the spinal canal and compressing the spinal cord between the posterior aspect of the vertebral body and the ligamentum flavum and lamina. Hyperextension injuries may result from facial or frontal trauma, whereby the forces separate the vertebral body and the adjacent lower end of the intervertebral disk. Hyperextension injuries are most common in the cervical region and are a common cause of lower cervical neck injuries (see Fig. Cole, in Cottrell and Young's Neuroanesthesia (Fifth Edition), 2010 Hyperextension

Hyper extension